AcuteCare Telemedicine Blog


Technology is Advancing the Practice of Telepsychiatry

Telepsychiatry and other long-distance options for providing mental health care can help overcome problems related to location and distribution of specialty mental health services but should not be seen as a panacea for delivering care to rural areas in the United States, reported a research and policy brief from the Maine Rural Health Research Center. “Telemental health” (yet another new term) once depended on heavy-duty audio and video technology based in fixed studios to initiate care. Despite this coarse beginning, advances in computer technology and its near-universal adoption have resulted in improved delivery of Telepsychiatry and made it more cost effective and available to a wider audience, however, some non-technical hurdles remain to be cleared.

Until recently, “Telemental health” services were most commonly provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners, but now a pilot project begun at one critical-access hospital in collaboration with a psychiatrist and specialty mental health staff at a community mental health center has expanded to five additional hospitals. This system provides round-the-clock crisis evaluation and support at the hospital emergency departments and some say that “Telemental health” enabled them to provide services to rural persons that otherwise would not be available, but some nontechnical barriers such as poor Medicaid and commercial reimbursement rates, recruitment and retention difficulties, high numbers of patients without insurance, and high no-show rates serve as a drag on expansion of current programs.

The barriers experienced with “Telemental health” expansion is shared by other medical service disciplines seeking to enter or expand the utilization of telecommunication technologies that promise to revolutionize the delivery of medical care in the United States and across the world.  While progress is being made to overcome many of the most significant structural road blocks to expansion and adoption of these new technologies, much remains to be done to clear the path to a new medical care delivery model.

Maintaining a consistent push to encourage state and congressional representatives and health insurance industry leaders to move forward and embrace the revolution in healthcare must continue until each barrier is removed or neutralized.  The promise of delivering better, less expensive and more available medical care to millions of patients across the country depends on these continued efforts progressing and succeeding.



Mobile Healthcare and Monitoring on the Brink of Revolution

Wireless in-home health monitoring is expected to increase six-fold in the next four years. A recent study by InMedica indicates that 308,000 patients were remotely monitored by their healthcare provider for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and mental health conditions worldwide in 2012. While congestive heart failure accounts for the majority of remote monitoring, it is expected that diabetes will supplant COPD with the second largest share of telehealth patients by 2017.  It is predicted that more than 1.8 million people worldwide will utilize mobile monitoring in the next four years.

Telemedicine is seen as a significant tool among healthcare providers for reducing hospital readmission rates, track patients chronic disease progression or provide advanced specialized medical treatment to patients in remote areas.  Four main factors are driving the demand for increased use of telemedicine and telehealth; Federal Readmission penalties introduced by the U.S. Center for Medicare and Medicaid Services (CMS);  healthcare providers desires to increase ties to patients and improve quality of care; insurance providers who are looking to increase their competitiveness and reduce in-patient pay-outs by working directly with telehealth suppliers to monitor their patient base; and an anticipation for future increased demand for telehealth services by patients.

Of the billions of dollars spent on health care each year, 75% to 80% of it goes for patients with chronic illnesses such as diabetes, heart disease, asthma and Alzheimer’s disease.  With rising costs and the anticipated shortage of physicians and healthcare providers over the next decade, utilizing the telemedicine technologies is becoming increasingly important to the routine delivery of medical services and monitoring of chronic diseases.

Even telepsychiatry, the use of secure Web-based video conferencing technology, and ambulatory patients, those who have been diagnosed with a disease at an ambulatory care facility but have not been hospitalized are expected to experience significant increased utilization of telemedicine among healthcare professionals in the next four years.  A plethora of emerging mobile technology, such as wearable wireless monitors to smartphone attachments will offer consumers the ability to track everything from core vital signs to impending heart attacks by discovering problems with heart tissue are on the horizon, offering a revolution in digital medical technology.

Speaking to those resisting the new mobile technology, Dr. Eric Topol, a professor of genomics at the Scripps Research Institute, recently encouraged the medical community to end paternal medicine, where only the physician has access to healthcare information, and to embark on a new beginning where patients own their data.  Dr. Topol compared the new mobile technology to the Gutenberg press and the way it revolutionized the way information was shared throughout the world.

We are embarking into a new era where patients have the mobile tools to better enable them to participate in their own medical diagnoses and treatment.



Now is the Time

Like any other year, the beginning of 2013 brings a great deal of optimism about what surprising changes and exciting opportunities and a new year will bring, not just to healthcare, but to our everyday lives. We are living in an age of constant innovation and untamed enthusiasm for what is new. Every day, we read news about the pioneering of new solutions for age-old problems and find ourselves astonished by what we can accomplish with the collective knowledge of generations past and a zeal for moving towards the future.

Telemedicine is a prime example of an entire industry fueled by this fervor for innovation, and the resulting advances it has brought to the way we think about healthcare are nothing short of remarkable. Unfortunately, the level of investment in terms of initial costs and putting trust in new technologies has been enough of an obstacle to prevent many facilities to postpone the adoption of telemedicine.

Embracing telemedicine is about far more than flashy new technology and the promise of saving costs; it is about taking steps forward to make our world a better place. For example, the latest tragedy to make national news out of Newtown, CT served as a stark reminder that there are still great strides that need to be made in order to address the needs of individuals with psychiatric conditions. Fortunately, through telepsychiatry programs and the drastic improvements in patient monitoring capabilities afforded by telemedicine, it is easier than ever before to get help. Extending the attention and the care that is so desperately needed in cases such as these will undoubtedly help us prevent many such worst-case scenarios.

It is the hope of AcuteCare Telemedicine and other proponents of telehealth that the plethora of new equipment and methods available to providers will continue to propel healthcare towards an era in which every individual has unhindered access to the care they need. There has never been a more important time to push the many benefits of telemedicine into the spotlight, and take the first steps towards achieving this goal.



Looking Backwards to See Ahead – Part 2: Accountability & Relationships

This is another in a series of blogs chronicling the development of AcuteCare Telemedicine (ACT). Much of this reflection involves lessons learned at 2011’s Annual Meeting of the American Telemedicine Association (ATA). What follows is an amalgam of facts, experience and opinions culled from that fantastic symposium and honed by hindsight. Today’s blog will focus on ACT’s approach to accountability and relationships.

Accountability refers to the promise of optimal healthcare outcomes while maintaining an expected return on investment. Patient and physician satisfaction are cornerstones of accountability, but to depend solely on these measures has become passé. Administrators want measurable financial and clinical outcomes, and to obtain and retain clients, will expect supporting data for all assertions.

One must constantly seek meaningful measures of the services promised; encounter surveys gather data on every patient interaction, regardless of outcome. This data measures service utilization (e.g. stroke vs non-stroke, tPA vs. non-tPA, etc.) and efficiency (e.g. response time, “door to needle” time, etc). Constant focus on patient outcome requires frequent Mordibity & Mortality conferences. This leads to continuing education, reduced miscommunication and shared responsibility. Finally, financial impact (more specifically than simply “satisfaction”) can be obtained with quarterly or annual reviews of year-to-date ICD-10 referenced charges or admissions. However, emotionally powerful patient anecdotes must complement the sterile numbers. It is this human component that provides the raison d’etre, separating telemedicine from any number of telecommunication ventures.

Accountability also extends to the development and maintainance of relationships with ACT’s clients. A client considering telestroke invests significant time and capital and must undergo a fundamental paradigm shift regarding what constitutes optimal patient care. To facilitate this endeavor, a telemedicine service needs to become as integrated as possible into the culture of its remote partners. One cannot afford to simply be the latest technological gimmick, but rather must provide an approachable solution.

Frequent contact is paramount and must not be limited to patient encounters. Not all interaction can take place in the cloud; physical meetings allow remote presence technology to become an alternate mode of communication between colleagues, rather than a proxy for an actual relationship. Communication is the foundation of every meaningful relationship. Listening to the client will uncover their goals and challenges.  The telemedicine service will integrate more fully with a remote partner, helping the client on their terms. This may result in vertical integration with mutually beneficial services including electrophysiology studies, clinical trials, medical directorships, etc.

Horizontal integration may include multiple disciplines such as telestroke, teleICU or telepsychiatry. Ultimately, integration into a client’s business model and culture is crucial for long-term sustainability. ACT assures clients are not simply invested in telemedicine services, but in their relationship with ACT.